TY - JOUR
T1 - Drug Development for Heart Failure With Preserved Ejection Fraction
T2 - What Pieces Are Missing From the Puzzle?
AU - Senni, Michele
AU - Greene, Stephen J.
AU - Butler, Javed
AU - Fonarow, Gregg C.
AU - Gheorghiade, Mihai
N1 - Publisher Copyright:
© 2017 Canadian Cardiovascular Society
PY - 2017/6
Y1 - 2017/6
N2 - Despite the growing number of patients with heart failure with preserved ejection fraction (HFpEF) and event rates comparable with many cancers, there remain no pharmacologic agents definitively proven to improve patient outcomes. Although phase II trials have intermittently yielded encouraging results, none have translated into successful achievement of a phase III primary end point. Thus, because of the urgent need to discover proven therapies, it is prudent to reevaluate our current approach to HFpEF drug development. In this review, we comment on key areas of uncertainty and importance relevant to successful drug discovery for HFpEF. These areas include the need to: clarify and homogenize the HFpEF definition; better understand the role of comorbidities and varying HFpEF etiology; use the heart failure hospitalization as the prime opportunity for trial enrollment; classify HFpEF patients within discrete clinicopathologic phenotypes for selected study; discover novel molecular drug targets; and determine predictors of specific causes of death to allow optimal matching of pharmacologic mechanisms with HFpEF subgroups most likely to benefit. Recognizing that the study of HFpEF is inherently challenging and complex, addressing these specific areas and overcoming their respective hurdles might maximize the chances of discovering a beneficial therapy.
AB - Despite the growing number of patients with heart failure with preserved ejection fraction (HFpEF) and event rates comparable with many cancers, there remain no pharmacologic agents definitively proven to improve patient outcomes. Although phase II trials have intermittently yielded encouraging results, none have translated into successful achievement of a phase III primary end point. Thus, because of the urgent need to discover proven therapies, it is prudent to reevaluate our current approach to HFpEF drug development. In this review, we comment on key areas of uncertainty and importance relevant to successful drug discovery for HFpEF. These areas include the need to: clarify and homogenize the HFpEF definition; better understand the role of comorbidities and varying HFpEF etiology; use the heart failure hospitalization as the prime opportunity for trial enrollment; classify HFpEF patients within discrete clinicopathologic phenotypes for selected study; discover novel molecular drug targets; and determine predictors of specific causes of death to allow optimal matching of pharmacologic mechanisms with HFpEF subgroups most likely to benefit. Recognizing that the study of HFpEF is inherently challenging and complex, addressing these specific areas and overcoming their respective hurdles might maximize the chances of discovering a beneficial therapy.
UR - http://www.scopus.com/inward/record.url?scp=85019593096&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85019593096&partnerID=8YFLogxK
U2 - 10.1016/j.cjca.2017.03.013
DO - 10.1016/j.cjca.2017.03.013
M3 - Review article
C2 - 28545624
AN - SCOPUS:85019593096
VL - 33
SP - 768
EP - 776
JO - Canadian Journal of Cardiology
JF - Canadian Journal of Cardiology
SN - 0828-282X
IS - 6
ER -